Tarallo P A, Smolowitz J, Carriero D, Tarallo J, Siegel A, Jia H, Emond J C
School of Nursing, Columbia University, Columbia University Medical Center, New York, New York 10032, USA.
Transpl Infect Dis. 2013 Aug;15(4):400-4. doi: 10.1111/tid.12086. Epub 2013 May 6.
We sought to assess the prevalence and risk factors for high-risk human papillomavirus (HPV) infection among female liver transplant (LT) candidates. Traditional health screening before LT listing has included Pap smear and is typically carried out by the patient's local provider. The prevalence of high-risk HPV in this population has not been studied.
With Institutional Review Board approval, 62 LT candidates received a liquid-based Pap smear with high-risk HPV testing as part of their pre-transplant evaluation by a single provider. Clinical variables included age, ethnicity, insurance status, prior Pap smear, and HPV results, HPV risk factors including age of first intercourse, number of lifetime partners, last sexual activity, smoking, birth control pill use, history of sexually transmitted infections, human immunodeficiency virus status, immunosuppressive medication, medical diagnoses, prescribed medications, and history of hepatitis A, B, C, or D.
The 62 women had a median age of 56 years, and 39% had high-risk behavior known to be associated with HPV. Ten of 62 patients (16.1%) had high-risk HPV at baseline screening, 5 of whom had atypical cytology. All of the patients who were positive for high-risk HPV had an etiology of hepatitis C virus (HCV) as the underlying cause of liver disease, with the majority (90%) having no history of high-risk behavior for HPV. In contrast, all patients with high-risk behavior who were HCV negative were HPV negative. Fisher's exact test demonstrated a statistically significant relationship between HPV and HCV; odds ratio = 24.4, 95% confidence interval, 1.4, 438.7, P-value = 0.0013. None of the other potential risk factors were associated with HPV in this cohort.
In this study, we provide evidence of a strong association between HCV and HPV in LT candidates, which has not been previously reported. HPV positivity was observed in non-sexually active women, suggesting a reactivation of dormant HPV. An association between hepatitis C and high-risk HPV could involve impairment of T-cell function by hepatitis C. These data support close surveillance in women's health screening for LT candidates. Further studies to characterize immune responses in these patients will be in order.
我们试图评估女性肝移植（LT）候选者中高危型人乳头瘤病毒（HPV）感染的患病率及危险因素。LT登记前的传统健康筛查包括巴氏涂片检查，通常由患者当地的医疗服务提供者进行。该人群中高危型HPV的患病率尚未得到研究。
经机构审查委员会批准，62名LT候选者接受了液基巴氏涂片检查及高危型HPV检测，这是由一名医疗服务提供者进行的移植前评估的一部分。临床变量包括年龄、种族、保险状况、既往巴氏涂片检查及HPV检测结果、HPV危险因素，如初次性交年龄、性伴侣数量、最近一次性活动、吸烟、口服避孕药使用情况、性传播感染病史、人类免疫缺陷病毒状态、免疫抑制药物、医学诊断、处方药物以及甲型、乙型、丙型或丁型肝炎病史。
这62名女性的中位年龄为56岁，39%有已知与HPV相关的高危行为。62例患者中有10例（16.1%）在基线筛查时存在高危型HPV，其中5例有非典型细胞学表现。所有高危型HPV阳性的患者均以丙型肝炎病毒（HCV）作为肝病的潜在病因，大多数（90%）无HPV高危行为史。相比之下，所有HCV阴性且有高危行为的患者HPV均为阴性。Fisher精确检验显示HPV与HCV之间存在统计学显著相关性；比值比=24.4，95%置信区间为1.4至438.7，P值=0.0013。该队列中的其他潜在危险因素均与HPV无关。
在本研究中，我们提供了证据表明LT候选者中HCV与HPV之间存在强关联，这在之前未曾报道过。在非性活跃女性中观察到HPV阳性，提示潜伏的HPV重新激活。丙型肝炎与高危型HPV之间的关联可能涉及丙型肝炎对T细胞功能的损害。这些数据支持对LT候选者的女性健康筛查进行密切监测。对这些患者的免疫反应进行特征描述的进一步研究将是必要的。
